Andersen Nicholas D, Borisuk Michele J, Hoganson David M, Rathod Rahul H, Baird Christopher W
Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Semin Thorac Cardiovasc Surg. 2019 Spring;31(1):99-101. doi: 10.1053/j.semtcvs.2018.08.005. Epub 2018 Sep 4.
Left main coronary artery (LMCA) stenosis is present in approximately 5% of patients with congenital supravalvular aortic stenosis (SVAS) (Fig. 1) and is associated with an increased risk of sudden cardiac death. However, patients undergoing coronary artery intervention at the time of SVAS repair are at the highest risk of experiencing major adverse cardiac events. Literature reports of surgical techniques and outcomes of concomitant coronary artery repair in these high-risk patients are diverse and inconsistently described. We have recently adopted a standardized surgical technique for management of this complex pathology by combining extended LMCA patch augmentation with a 3-patch aortic root reconstruction (Brom's technique). In this report, we describe our contemporary surgical technique of 3-patch aortic root reconstruction with extended LMCA patch augmentation for patients with congenital SVAS with ostial LMCA stenosis and bilateral outflow tract obstruction. Institutional review board approval was obtained for retrospective review of patient charts.
先天性瓣上主动脉狭窄（SVAS）患者中约5%存在左主干冠状动脉（LMCA）狭窄（图1），且与心源性猝死风险增加相关。然而，在SVAS修复时接受冠状动脉介入治疗的患者发生主要不良心脏事件的风险最高。关于这些高危患者同期冠状动脉修复的手术技术和结果的文献报道多种多样且描述不一致。我们最近采用了一种标准化手术技术来处理这种复杂病变，即将扩大的LMCA补片扩大术与三补片主动脉根部重建术（布罗姆技术）相结合。在本报告中，我们描述了针对伴有LMCA开口狭窄和双侧流出道梗阻的先天性SVAS患者，采用三补片主动脉根部重建术并扩大LMCA补片的当代手术技术。已获得机构审查委员会批准，以对患者病历进行回顾性审查。
